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Hepatic manifestations in typhoid fever
K Jagadish1, A K Patwari, S K Sarin
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi.
Insights
Multidrug-resistant typhoid fever in children often causes temporary liver dysfunction, including elevated liver enzymes and jaundice. These hepatic issues typically resolve within weeks of effective antibiotic treatment.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Microbiology
Background:
- Typhoid fever, caused by *Salmonella Typhi*, remains a significant global health concern.
- Multidrug resistance in *S. Typhi* complicates treatment and may influence disease manifestations.
- Hepatic involvement in pediatric typhoid fever is recognized but requires detailed characterization.
Purpose of the Study:
- To prospectively evaluate hepatic function in children with multidrug-resistant typhoid fever.
- To assess the prevalence and nature of hepatic manifestations during hospitalization.
- To determine the reversibility of hepatic dysfunction after antibiotic therapy.
Main Methods:
- Prospective study of 31 children (2 months to 12 years) with blood culture-confirmed multidrug-resistant *S. Typhi*.
- Assessment of liver function tests, including SGOT, SGPT, AP, SB, SA, and PT at admission and 2-3 weeks post-treatment.
- Clinical examination for hepatomegaly and abdominal ultrasound were performed.
Main Results:
- Hepatomegaly (51.6%) and elevated liver enzymes (SGOT 61.3%, SGPT 48.4%) were common.
- Hepatic dysfunction was present even in children without hepatomegaly.
- All liver function parameters normalized within 2-3 weeks after successful antibiotic therapy, indicating transient dysfunction.
Conclusions:
- Pediatric typhoid fever, particularly multidrug-resistant strains, frequently presents with transient hepatic dysfunction.
- Liver function abnormalities are common and can occur independently of hepatomegaly.
- Successful antibiotic treatment leads to the resolution of hepatic manifestations.
Abstract:
Thirty one children with typhoid fever aged 2 months to 12 years and blood culture positive for multidrug resistant S. typhi were prospectively studied for their hepatic functions at the time of hospitalization and 2-3 weeks after completion of antibiotic therapy. Hepatic manifestations included hepatomegaly (51.6%); jaundice (16.1%); raised levels of serum glutamic oxaloacetic transaminase (SGOT) (61.3%), serum glutamic pyruvic transaminase (SGPT) (48.4%), alkaline phosphatase (AP) (22.6%) and serum bilirubin (SB) (6.1%); reduced levels of serum albumin (SA) (41.9%); prolonged prothrombin time (PT) (9.7%) and abnormal ultrasound abdomen (19.3%). Hepatic dysfunction was a notable feature even in those cases without hepatomegaly, with raised levels of SGOT (60%), SGPT (40%), AP (20%), SB (6.7%), decreased SA (53.3%) and prolonged PT (6.7%). There was no correlation between the degree of hepatic enlargement or hyperbilirubinemia with abnormalities in liver functions. Hepatic dysfunction was noticed to be transient, as all these parameters returned to normal within 2-3 weeks after successful antibiotic therapy.